HomeMy WebLinkAboutCLE200600305 Legacy Document 2015-02-10Application for
Zoning Clearance
Zoning Clearance = $35
PLEASE REVIEW ALL 3 SHEETS
Tax map and parcel: s 6^ 1 Q_ Existing Zoning: K
Parcel Owner: �' \• �oW� C t���1CkL`P.�l� ,U `+n
Parcel Address: J�7� ...) ,mo,�p � P City C tbZ.efi State Vf� Zip ;Q93,
(include suite or floor) f
Contact Person (Who should we call /write concerning this project ?): 1`1C� t M `ml�z ' M IP
Address 114 1 C) &-o' m Q tA I L-L- City
Daytime Phone lUO L45(P _ (.q9S_ Fax # (_)
P—V-00 f� (Y� State VA Zip zaq
_E -mail 1`1 (Ml -Q.►Sr. CG-). oz • '��i
Business Name /Type: C o c_oM P A:- S HACAAP A , LUL Z PrWWC34
SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1)
Circle (if applicable): Fireworks / Christmas Tree
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a
new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information
provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will
abide by them.
�e�� 12
SignaturM, oqf Business Owner or AgAnt Date
Print Name
APPROVAL INFORMATION
[ ] Approved as proposed [V]Approved with conditions
[ v ackflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119.
L4No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan.
[ ] This site complies witty they site plan as of this date.
Building Official �— Date
Zoning Official Date 0
Other Official Date
FOR OFFICF U %ONLY CLE # 7 —Ors 3Qs
Fee Amount $ 5 Date Paid o7 By who? �iic Eai2E Receipt # � Ck# � By: .
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of 4
Applicant to complete the following:
I
Do you have one of the following?
12/1y"ES ❑ NO
Tax Map and Parcel Number and or;
Address of use (include unit or floor if appropriate)
YES ❑ NO
Do you have a Floor Plan (sketch or an architectural drawing) that
includes the following, and if so please provide it with the
application?
The total square footage of the use and /or;
The square footage of each room or area of use;
Use of each room or area
If using less than the entire structure, note the location within the
structure.
coning Tech
Violations:
❑ YES [
If so, List:
complete the followin
NO
Variance:
❑ YES [AINO
If so, List:
Intake to complete the following:
❑ YES [0NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
❑
NO
YES V/
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
❑ YES [91NO
Is parcel on private well and septic?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from
Health Dept. FAX DATE
[YES ❑ NO
Is on public water and sewer?
❑ YES 0/NO
Will you be putting up a new sign of any kind? If so, obtain
proper Sign permit.
Permit #
❑ YES P NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
❑ YES ED/NO
Is this for sales of Fireworks?
If so, obtain a copy of F/R permit.
Permit #
Proffers:
❑ YES [�/NO
If so, List:
SP's:
❑ YES NO
If so, List:
5/1/06 Page 3 of
Reviewer to complete the following:
Square footage of Use:
Permitted as: 60 t, �
Under Section: i 00/i Dy
Supplementary regulations section:
Parking formula: I /.I Mv4a
Required spaces:
❑ YES Z NO
Items to be verified in the field:
Inspector Name & Date:
Notes
5/1/06 Page 4 of 4